bubble_chart Overview

Acute catarrhal conjunctivitis, commonly known as "red eye" or "fire eye," is a common acute epidemic eye disease caused by bacterial infection. Its main characteristics are obvious conjunctival congestion, purulent or mucopurulent discharge, and a tendency to self-heal.

bubble_chart Etiology

The common pathogenic bacteria include Diplococcus pneumoniae, Koch-Weeks bacillus, Haemophilus influenzae, Staphylococcus aureus, and Streptococcus. The latter two bacteria can normally reside in the conjunctival sac without causing conjunctivitis. However, they may trigger acute conjunctivitis in cases of other conjunctival disorders or when local or systemic resistance is reduced. Bacteria can directly contact the conjunctiva through various vectors, spreading rapidly in public places and group settings such as kindergartens, schools, and households, leading to outbreaks. Particularly in spring and autumn, when respiratory diseases like influenza and rhinitis are prevalent, conjunctivitis-causing bacteria may be transmitted through respiratory secretions.

bubble_chart Clinical Manifestations

The patient experiences a sensation of eye irritation and a foreign body feeling, with severe cases exhibiting heavy eyelids, photophobia, tearing, and a burning sensation. Sometimes, due to secretions adhering to the corneal surface in the pupillary area, temporary blurred vision occurs, which can be restored after rinsing. Due to inflammatory stimulation producing a large amount of mucopurulent discharge, patients may find their upper and lower eyelids stuck together by secretions upon waking in the morning. When the lesion involves the cornea, symptoms such as photophobia, pain, and decreased vision become significantly worse. A few patients may also have concurrent upper respiratory infections or other systemic symptoms.

Upon examination, eyelid swelling is observed, and the conjunctiva shows the upper and lower eyelids stuck together by secretions. When the lesion involves the cornea, symptoms such as photophobia, pain, and decreased vision become significantly worse. A few patients may also have concurrent upper respiratory infections or other systemic symptoms.

Examination reveals eyelid swelling, and the conjunctiva appears bright red due to congestion, most prominently in the palpebral and fornical conjunctiva. In severe cases, the conjunctival surface may be covered by a pseudomembrane that can be easily rubbed off, hence the term pseudomembranous conjunctivitis. The bulbar conjunctiva shows varying degrees of congestion and edema, losing its transparency. The cornea, conjunctival surface, and eyelid margins are covered with mucoid or purulent secretions. If infected by Koch-Weeks bacillus or pneumococcus, the conjunctiva may exhibit severe congestion and edema accompanied by scattered small patchy hemorrhages. Corneal complications are mainly caused by Koch-Weeks bacillus, manifesting as catarrhal corneal marginal infiltration or ulcers. The lesions initially appear as superficial punctate corneal infiltrations located on the inner side of the corneal margin, which later fuse to form an arcuate superficial ulcer. After healing, a cloudy nebula may remain.

Generally, the condition peaks within 3–4 days of onset and then gradually improves, with recovery taking about 10–14 days. Cases caused by Koch-Weeks bacillus or pneumococcus infection are more severe and may sometimes be accompanied by systemic symptoms such as fever and general malaise. The course of the disease may last about 2–4 weeks. This condition often affects both eyes simultaneously or within 1–2 days of each other.

bubble_chart Treatment Measures

In the early and peak stages of the disease, perform secretion smears or conjunctival scrapings to identify the pathogenic bacteria and conduct drug sensitivity tests to select effective medications for treatment. Generally, in the advanced stage, the positive rate of bacteriological examination is lower.

For patients with abundant secretions, rinse the conjunctival sac with a 3% boric acid solution or saline. If secretions are minimal, use a sterilized cotton swab dipped in the aforementioned solution to clean the eyes.

Early cold compresses can alleviate the ocular discomfort symptoms caused by this condition.

Local treatment: Depending on the causative bacteria, use various antibiotic eye drops such as 10% sulfacetamide sodium, 0.25% chloramphenicol, 0.5–1.0% erythromycin solution, or neomycin. Adjust the frequency from every 2–3 hours to hourly based on the severity. Apply antibiotic ointments like 0.5% tetracycline, erythromycin, or chlortetracycline before bedtime to prevent eyelid adhesion and prolong the retention of medication in the conjunctival sac. In cases complicated by keratitis, manage it as keratitis.

Treatment should be timely and thorough to prevent recurrence.

bubble_chart Prevention

Since the disease is highly contagious through contact with pestilence and can easily cause widespread outbreaks, strict attention must be paid to disinfection and isolation once a case is identified in households or collective living environments. Personal items such as the patient's face-washing utensils and handkerchiefs must be disinfected by boiling. Medical personnel should take precautions to prevent cross-infection after examinations and treatment procedures.